Pituitary Microadenomas Clinical Presentation

  • Author: David M Klachko, MBBCh; Chief Editor: George T Griffing, MD   more...
 
Updated: May 18, 2011
 

History

  • Types of pituitary microadenomas
    • Incidentalomas usually have no associated symptoms. They are ordinarily found in people who have radiologic studies for other reasons (eg, headaches). Unlike macroadenomas, incidentalomas are too small to cause pressure-related symptoms such as headache or visual field loss.
    • Prolactinomas may be asymptomatic if prolactin levels are only slightly elevated. In women, hyperprolactinemia may cause galactorrhea, amenorrhea, or infertility. In men, hypogonadism, erectile dysfunction, and decreased libido may ensue. Gynecomastia may develop but galactorrhea is rare in men.
    • ACTH-secreting adenomas cause Cushing disease.
    • Growth hormone–secreting adenomas cause acromegaly.
    • TSH-secreting adenomas are a very rare cause of hyperthyroidism.
    • Gonadotropin-secreting adenomas have been reported. The frequency is unknown. Women may present with amenorrhea and a mismatch between estrogen and gonadotropin levels (eg, elevated gonadotropin levels despite normal or elevated levels estrogen levels without suppression of gonadotropins).
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Physical

Any physical abnormalities are caused by excessive hormone secretion (eg, galactorrhea due to hyperprolactinemia, acromegaly due to excessive growth hormone, ACTH-mediated Cushing disease). Many microadenomas found incidentally on CT scan or MRI may be clinically inactive.

  • Patients with prolactin-secreting adenomas may present with infertility, galactorrhea, amenorrhea, and loss of libido. Weight gain is frequent and may be reversed in some patients with normalization of prolactin levels.
  • Growth hormone–secreting adenomas cause acromegaly with coarsening of facial features and soft tissue swelling of the hands and feet. Most patients complain of excessive perspiration and offensive body odor. Progressive bony proliferation occurs, and the mandible lengthens and thickens, resulting in an underbite.
  • ACTH-secreting adenomas cause Cushing disease characterized by weight gain, primarily in the facial, nuchal, truncal, and girdle areas (ie, centripetal or "buffalo" obesity). Protein breakdown leads to thin, friable skin that bruises easily; breakdown may form wide striae and may cause muscle weakness, wasting, and osteopenia. In children, growth is arrested.
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Causes

As with adenomas elsewhere, the likely cause of pituitary microadenomas is a local mutation leading to autonomous growth and/or secretion.

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Contributor Information and Disclosures
Author

David M Klachko, MBBCh  Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri

David M Klachko, MBBCh is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, Endocrine Society, Missouri State Medical Association, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Harris C Taylor, MD  Clinical Professor of Medicine, Division of Clinical and Molecular Endocrinology, Case Western Reserve University School of Medicine

Harris C Taylor, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Thyroid Association, and Endocrine Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Yoram Shenker, MD  Chief of Endocrinology Section, Veterans Affairs Medical Center of Madison; Interim Chief, Associate Professor, Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Wisconsin at Madison

Yoram Shenker, MD is a member of the following medical societies: American Heart Association, Central Society for Clinical Research, and Endocrine Society

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

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MRI showing a nonenhancing area in the pituitary consistent with a microadenoma in a patient with hyperprolactinemia.
 
 
 
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